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Adenosine-assisted clipping of intracranial aneurysms

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Abstract

Temporary parent vessel clip occlusion in aneurysm surgery is not always practical or feasible. Adenosine-induced transient cardiac arrest may serve as an alternative. We retrospectively reviewed our clinical database between September 2011 and July 2014. All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole were included. A total of 18 craniotomies were performed, and 18 aneurysms were clipped under adenosine-induced asystole (7 basilar arteries, 8 internal carotid arteries, 1 middle cerebral artery, and 1 anterior communicating artery) in 16 patients (10 females, 6 males). Nine cases were elective and seven after subarachnoid hemorrhage. Mean age was 54 years (range 39–70). The indications for adenosine use were proximal control in narrow surgical corridors in 13 cases and “aneurysm softening” in 4 cases. A single dose was used in 14 patients; 3 patients had multiple boluses. The median (range) total dose was 30 (18–135) mg. Adenosine induced a bradycardia with concomitant arterial hypotension in all patients, and the majority also had asystole for 5–15 sec. Transient cardiac arrhythmias were noted in one patient (AFib in need of electroconversion after two boluses). Nine clinical scenarios where adenosine-induced temporary cardiac arrest and deep hypotension was an effective adjunct to temporary clipping during microsurgical clipping of intracranial aneurysms were identified.

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Authors and Affiliations

  1. Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, 0027, Oslo, Norway

    Torstein R. Meling, Per Kristian Eide, Angelika G. Sorteberg & Wilhelm A. Sorteberg

  2. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

    Torstein R. Meling, Per Kristian Eide & Angelika G. Sorteberg

  3. Department of Anesthesiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway

    Luis Romundstad, Geir Niemi & Jon Narum

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  1. Torstein R. Meling
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  2. Luis Romundstad
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  3. Geir Niemi
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  4. Jon Narum
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Correspondence to Torstein R. Meling.

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The hospitals’ Data Protection Officials approved the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The authors do not have any personal or institutional financial interest in drugs, materials, or devices described in the article.

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Meling, T.R., Romundstad, L., Niemi, G. et al. Adenosine-assisted clipping of intracranial aneurysms. Neurosurg Rev 41, 585–592 (2018). https://doi.org/10.1007/s10143-017-0896-y

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  • DOI: https://doi.org/10.1007/s10143-017-0896-y

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